How should providers handle issues around sick workers and transfers from local hospitals?
How should long-term care settings respond when workers show symptoms of COVID-19? How should those settings handle the anticipated transfer of recovering COVID-19 patients from local hospitals?
The authors of a recent editorial in JAMDA, have a few ideas—including a recommendation that you consult interim recommendations from AMDA, The Society for Post-Acute and Long-Term Care Medicine.
SICK WORKERS
Each long-term care setting should develop a policy for identifying workers who become sick, and for allowing sick workers to be absent from work, the authors advise.
“It is noteworthy that many long-term care workers live paycheck-to-paycheck in an environment without reserve staffing; they therefore may be conditioned to report even when sick,” they write. “Providing a work environment that allows health care workers to call out without repercussion will be critically important.”
TRANSFERS FROM ACUTE-CARE SETTINGS
LTSS providers will also need a way to determine if or when to admit individuals discharged from hospitals after treatment for COVID-19.
“Long-term care facilities are a key component of our health care system, and we can anticipate significant pressure to receive discharged hospitalized patients for convalescence or to accommodate sicker patients arriving from the community,” write the authors.
This is a difficult question, they admit, since we don’t yet know how long individuals with COVID-19 are infectious. Data from 4 Chinese patients who contracted COVID-19 and recovered indicate that the virus was still present at 5 to 13 days post infection and then on subsequent testing.
“It is unclear whether this meant that they were continuously infectious or re-infected, but should give pause as to when recovering COVID-19 patients are safe to bring into a facility where rapid transmission of the virus to a susceptible population could occur,” the authors write. “Further research into the post-infectious period will be critical to developing further guidance.”
Until that research is available, the authors recommend, “patients who are newly admitted should likely remain isolated behind a closed door for 7 to 14 days to reduce the risk of serving as the vector for an explosive outbreak among high-risk individuals.”